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Gajjar AA, Covell MM, Prem Kumar R, Tang OY, Ranganathan S, Muzyka L, Mualem W, Rehman I, Patel SV, Lavadi RS, Mitha R, Lieber BA, Hamilton DK, Agarwal N. Evidence Against a Traumatic Brain Injury "July Effect": An Analysis of 3 160 452 Patients From the National Inpatient Sample. Neurosurgery 2024:00006123-990000000-01281. [PMID: 38990004 DOI: 10.1227/neu.0000000000003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The "July Effect" hypothesizes increased morbidity and mortality after the addition of inexperienced physicians at the beginning of an academic year. However, the impact of newer members on neurosurgical teams managing patients with traumatic brain injury (TBI) has yet to be examined. This study conducted a nationwide analysis to evaluate the existence of the "July Effect" in the setting of patients with TBI. METHODS The Healthcare Cost and Utilization Project Central Distributor's National Inpatient Sample data set was queried for patients with TBI using International Classification of Diseases (ICD)-9 and ICD-10 codes. Discharges were included for diagnoses of traumatic epidural, subdural, or subarachnoid hemorrhages. Only patients treated at teaching hospitals were included to ensure resident involvement in care. Patients were grouped into July admission and non-July admission cohorts. A subgroup of patients with neurotrauma undergoing any form of cranial surgery was created. Perioperative variables were recorded. Rates of different complications were assayed. Groups were compared using χ2 tests (qualitative variables) and t-tests or Mann-Whitney U-tests (quantitative variables). Logistic regression was used for binary variables. Gamma log-linked regression was used for continuous variables. RESULTS The National Inpatient Sample database yielded a weighted average of 3 160 452 patients, of which 312 863 (9.9%) underwent surgical management. Patients admitted to the hospital in July had a 5% decreased likelihood of death (P = .027), and a 5.83% decreased likelihood of developing a complication (P < .001) compared with other months of the year. July admittance to a hospital showed no significant impact on mean length of stay (P = .392) or routine discharge (P = .147). Among patients with TBI who received surgical intervention, July admittance did not significantly affect the likelihood of death (P = .053), developing a complication (P = .477), routine discharge (P = .986), or mean length of stay (P = .385). CONCLUSION The findings suggested that there is no "July Effect" on patients with TBI treated at teaching hospitals in the United States.
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Affiliation(s)
- Avi A Gajjar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael M Covell
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Rohit Prem Kumar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Oliver Y Tang
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Logan Muzyka
- Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - William Mualem
- Department of General Surgery, Temple University, Philadelphia, Pennsylvania, USA
| | - Inaya Rehman
- Department of Biology, San Jose State University, San Jose, California, USA
| | - Shrey V Patel
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bryan A Lieber
- Department of Neurosurgery, Dr. Kiran C. Patel College of Allopathic Medicine Nova Southeastern University Davie, Fort Lauderdale, Florida, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Neurological Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Menditto VG, Rossetti G, Sampaolesi M, Buzzo M, Pomponio G. Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department. J Clin Med 2024; 13:3669. [PMID: 38999235 PMCID: PMC11242576 DOI: 10.3390/jcm13133669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
The best management of patients who suffer from traumatic brain injury (TBI) while on oral anticoagulants is one of the most disputed problems of emergency services. Indeed, guidelines, clinical decision rules, and observational studies addressing this topic are scarce and conflicting. Moreover, relevant issues such as the specific treatment (and even definition) of mild TBI, rate of delayed intracranial injury, indications for neurosurgery, and anticoagulant modulation are largely empiric. We reviewed the most recent evidence on these topics and explored other clinically relevant aspects, such as the promising role of dosing brain biomarkers, the strategies to assess the extent of anticoagulation, and the indications of reversals and tranexamic acid administration, in cases of mild TBI or as a bridge to neurosurgery. The appropriate timing of anticoagulant resumption was also discussed. Finally, we obtained an insight into the economic burden of TBI in patients on oral anticoagulants, and future directions on the management of this subpopulation of TBI patients were proposed. In this article, at the end of each section, a "take home message" is stated.
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Affiliation(s)
- Vincenzo G Menditto
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Giulia Rossetti
- Internal Medicine, Santa Croce Hospital AST1 Pesaro Urbino, 61032 Fano, Italy
| | - Mattia Sampaolesi
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Marta Buzzo
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Giovanni Pomponio
- Clinica Medica, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
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Al-Rahbi A, Al Mahrouqi O, Al Ibrahim H, Al Saidi M, Abid Shah Y, Al-Saadi T. Cost Associated with Geriatric Traumatic Brain Injury in Developing Countries: An Observational Study. World Neurosurg 2024; 181:e990-e1000. [PMID: 37952885 DOI: 10.1016/j.wneu.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) in the geriatric population is a serious public health problem and has a huge impact on mortality and morbidity. METHODS A retrospective cohort study including patients aged above 65 admitted to a tertiary specialized trauma center, in the period from January 2016 to 31 December 2019. The data collected include patients' demographics, diagnosis, Glasgow Coma Scale (GCS) on arrival, length of stay, investigations, and type of surgery done. RESULTS Total number of TBI cases in our study is 145. The most frequent single diagnosis was subdural hematoma (85). Subsequently, it was the costliest diagnosis with an average cost of 3569 USD per patient. Length of stay on average was 17.11 ± 41 hours, with the majority (109 patients) having nonprolonged hospital stay (<14 days). Most of those managed by observation have below-average costs compared to other patients (P < 0.001). Complete blood count was the highly requested test with a total cost 5070 $ in the study period. And head computed tomography had the highest total cost 58,864 $. 21 craniotomies and 30 burr holes were made with a total cost of 30,000 and 25,325 respectively. Patients with lower GCS (64.6%) have below-average hospitalization costs compared to those who got high GCS scores (P < 0.001). CONCLUSIONS This study provides the first estimates of the financial burden of Geriatric TBI in the region, which signifies the importance of developing strategies to prevent TBIs and help in resource allocation and healthcare policy formation.
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Affiliation(s)
- Adham Al-Rahbi
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Omar Al Mahrouqi
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Hashim Al Ibrahim
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Maryam Al Saidi
- College of Medicine & Health Sciences, Oman Medical Specialty Board, Muscat, Sultanate of Oman
| | - Yusra Abid Shah
- College of Medicine & Health Sciences, National University of Science and Technology, Sohar, Oman
| | - Tariq Al-Saadi
- Department of neurosurgery, Khoula Hospital, Muscat, Sultanate of Oman; College of Medicine & Health Sciences, McGill University, Montreal, Quebec, Canada.
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